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Sports medicine doctor explains Embiid's knee injury, prognosis originally appeared on NBC Sports Philadelphia
The Sixers on Wednesday announced that their MVP finalist has a small lateral meniscus tear in his right knee. The team classified Joel Embiid as “day to day” and said he’d receive physical therapy and other treatment.
What exactly is a small lateral meniscus tear, and what’s the prognosis for Embiid beyond the general “day to day” designation?
NBC Sports Philadelphia discussed Embiid’s situation Wednesday with Dr. John Vasudevan, a sports medicine doctor at Penn Medicine and an assistant professor of clinical physical medicine and rehabilitation. Vasudevan is not treating Embiid.
What is the injury?
“The (meniscus injuries) that are of greater consequence are the medial meniscus — on the inside of the knee,” Vasudevan said. “Whereas the lateral meniscus — on the outside of the knee — is not where most of your weight bearing occurs. For the average person, it’s less likely to lead to surgery. The problem is it’s Joel Embiid and he’s in a multi-directional professional sport. So a lateral meniscus might be of more consequence than to the average person.”
The Sixers have called Embiid’s injury a “small tear,” and he was able to run through his typical pregame workout before Game 5 of the Sixers’ first-round series against the Wizards.
According to Vasudevan, instability is “far more concerning” with meniscus tears than pain or swelling, though the Sixers will need to monitor those symptoms.
When could he come back?
Decreased pain, decreased swelling and “strength that’s at least 90 percent of the opposite side” would be general indicators in support of Embiid returning, per Vasudevan.
Ideally, physical therapy will help on those fronts.
“For the first part, on pain and swelling, they’ll use ice and heat and massage and a lot of modalities to try to assist — along with medications or injections — to bring that pain and swelling down. … What they do is progressively challenge not just the muscles that go around the knee, but muscles of the hip area and ankle area, so they can support his knee,” Vasudevan said. “No matter how well his knee is doing in the coming weeks, he’s still going to deal with some pain. The question is whether he can perform with the help of the hip and the ankle … to make those motions he needs.”
What are potential downsides of playing through pain?
Vasudevan called the “can versus should” question one of the toughest issues for any sports medicine doctor.
“It really requires ruling out the big, bad stuff,” he said. “One, no fracture or instability. Then you’re going to look at, what is the trajectory of his pain and swelling? The first three weeks are going to be his most challenging. Can he play through it? Sure, but (he's) going to be sensitive to pain or swelling. And that may dictate how much time he gets on the floor.”
Though Embiid spoke about being bothered by the brace he wore after suffering a left knee bone bruise in March, Vasudevan said he wouldn’t be surprised if the 27-year-old sported a knee brace upon returning. However, wearing a brace might not fully align with Embiid’s physical therapy goals.
“The whole hope is he advances in rehabilitation without a knee brace,” Vasudevan said, “because a knee brace will give you some support, but it also hinders the muscles you want to get strong. But the caveat is, in the time and moment you’re at (in the playoffs), if he needs something above and beyond what his body is giving him.
“The knee brace, what it does is not just stability. The medical term is proprioception, but what it means is it kind of reminds you where you are on the court. The more you bend and the more you play, the more the fabric of that brace is telling your knee and your brain, ‘You don’t want to take it that far.’ Right now he’s going to have to be a little bit more cautious to not exacerbate that pain and swelling.”
What will Embiid’s offseason look like?
Embiid will likely have “plenty of rehabilitation” in the offseason, Vasudevan said.
It appears surgery is not on the table at the moment unless Embiid were to have a significant setback, but might it be after the season concludes?
“This goes down to the physical findings, the imaging findings and the trajectory of his progress. … By six to 12 weeks is where you really determine, can you ramp yourself back up? By six weeks, if he’s not really seeing a lot of improvement, that’s concerning,” Vasudevan said. “And by six weeks, I’d expect he will see improvement. But the question is at six to 12 (weeks), if they really try to push him harder, does he keep getting recurrent or unpredictable exacerbation? I’d think in weeks six to 12, you’ll hear whether he needs surgery or not.”
On the surface, Embiid’s official day-to-day status and the fact that the Sixers saw no problems with him running through his usual pregame workout Wednesday both seem encouraging.
We’ll learn more in the coming days and weeks. The Sixers' hope will clearly be that he trends in a positive enough direction to play and do so at a high level.